Provider Demographics
NPI:1639423577
Name:SAGE SUPPORT SERVICES
Entity Type:Organization
Organization Name:SAGE SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:NEESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-435-9226
Mailing Address - Street 1:11121 BLADE CREST WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-5076
Mailing Address - Country:US
Mailing Address - Phone:502-435-9226
Mailing Address - Fax:
Practice Address - Street 1:11121 BLADE CREST WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-5076
Practice Address - Country:US
Practice Address - Phone:502-435-9226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty